A Morton’s neuroma is an inflamed, thickened nerve in the ball of the foot. The common symptoms are pain, tingling and numbness in the ball of the foot and shooting to the 2nd and 3rd toes. It’s common to experience a feeling of walking on a lump or bunched up sock. Morton’s neuroma involves a thickening of the tissue around one of the nerves leading to your toes. This can cause a sharp, burning pain in the ball of your foot. Your toes also may sting, burn or feel numb.

Cause
Morton’s neuroma seems to occur in response to irritation, pressure or injury to one of the nerves that lead to your toes.

Factors that appear to contribute to Morton’s neuroma include:

High heels: Wearing high-heeled shoes or shoes that are tight or ill fitting can place extra pressure on your toes and the ball of your foot.Certain sports.

Participating in high-impact athletic activities: Such as jogging or running may subject your feet to repetitive trauma. Sports that feature tight shoes, such as snow skiing or rock climbing, can put pressure on your toes.

Foot deformities: People who have bunions, hammertoes, high arches or flatfeet are at higher risk of developing Morton’s neuroma.

During the exam, your doctor will press on your foot to feel for a mass or tender spot. There may also be a feeling of “clicking” between the bones of your foot.

Imaging tests
Some imaging tests are more useful than others in the diagnosis of Morton’s neuroma:

X-rays: Your doctor is likely to order X-rays of your foot, to rule out other causes of your pain — such as bone cyst, arthritis or stress fracture.

Ultrasound: This technology uses sound waves to create real-time images of internal structures. Ultrasound is particularly good at revealing soft tissue abnormalities, such as neuromas.

Magnetic resonance imaging (MRI): Using magnetic radio waves and a strong magnetic field, an MRI also is good at visualizing soft tissues.

Treatment
Common treatments include rest, ice, anti-inflammatory medications, therapy, padding, rigid shoes, orthotics and injections and surgery.

Therapy
Arch supports and foot pads fit inside your shoe and help reduce pressure on the nerve. Dr. Fahoury may prescribe a custom-made, individually designed shoe insert — molded to fit the exact contours of your foot with a specially designed pad to alleviate pressure off the nerve.
Surgical and other procedures
If conservative treatments haven’t helped, your doctor might suggest:
Injections: Some people are helped by the injection of steroids (cortisone) into the painful area.
Cortisone is a steroid that is commonly used to reduce inflammation. In the case of a neuroma, cortisone is injected around the neuroma to reduce the nerve swelling and relieve the pressure. It is not intended to cure this condition; however, these injections are meant to shrink the neuroma so that it is no longer painful.

Dehydrated Alcohol Injections: Alcohol injections are an effective treatment for neuromas which have not responded to conservative therapy. Alcohol is a nerve sclerosing agent, which means the alcohol (ethanol) causes a chemical destruction of the nerve and decreases it’s ability to transmit sensation. Sclerosis injection is a diluted to a 4% alcohol solution which is injected near the site of the neuroma. These injections are often called chemical surgery because of their effectiveness in reversing the neuroma. They are administered to destroy the painful nerve bundle inside the neuroma, while keeping the outer walls intact to promote normal nerve regeneration.

Decompression surgery: In some cases, pressure can be relieved on the nerve by endoscopically cutting nearby structures, such as the ligament that binds together some of the bones in the front of the foot. Endoscopic decompression of intermetatarsal neuroma (EDIN) procedure is to release the intermetatarsal nerve, preserving sensation in the forefoot. This differs from a traditional Morton’s neuroma surgery in which the nerve is removed.

Removal of the nerve: Surgical removal of the growth may be necessary if other treatments fail to provide pain relief. Although surgery is usually successful, in some cases the procedure can result in permanent numbness in the affected toes. In such cases where surgery is warranted there are two approach types to the surgery the patient could be asked to undergo. One procedure calls for incisions to reach the neuroma through the bottom of the foot. This would require a period of non-weight bearing while the incision heals. The other, called the dorsal approach, calls for incisions made at the top of the foot. Each has it’s advantages/disadvantages but Surgeons prefer the dorsal procedure because it doesn’t temporarily disable the patient, requiring him to use crutches. Plus the skin of the bottom of the foot also takes a longer time to heal.

Removal neuroma dorsal approach

Plantar Approach